The surgical management of stress urinary incontinence should entail the careful workup of the patient in a specialist female urology or urogynaecology clinic. The patient should have tried pelvic floor muscle training for a minimum of 3 months prior to being considered a candidate for surgery. The clinician needs to particularly consider the patient’s past obstetric, gynaecological and urological history and make efforts to decipher red flag symptoms, other types of incontinence, medications and past medical history, including BMI. Treatments fall under two main categories: supportive and occlusive procedures. Supportive procedures include mid-urethral tapes, rectus fascial sling and colposuspension. Occlusive procedures include urethral bulking and artificial urinary sphincter insertion. Prior surgery undertaken, awareness of the mesh controversy, and concomitant pelvic organ prolapse play their part in the decision-making process when offering a tailor-made approach to women. Guidance recommends using a decision aid flowchart to help women reach a decision. This chapter uses an evidence-based approach to consider the possible indications for, and rationale for each surgical procedure whilst providing a contemporary review to guide clinicians in treatment choices.